Provider Demographics
NPI:1659518629
Name:DUPUIS, SARA BETH (LP, LMFT)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:BETH
Last Name:DUPUIS
Suffix:
Gender:F
Credentials:LP, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1727 WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-2948
Mailing Address - Country:US
Mailing Address - Phone:517-944-4232
Mailing Address - Fax:517-993-5200
Practice Address - Street 1:1905 ABBOT RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8571
Practice Address - Country:US
Practice Address - Phone:517-944-4232
Practice Address - Fax:517-993-5200
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014845103TC0700X
MI4101006452106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist